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Objectives
Despite an absence of evidence that Rho(D) immune globulin is necessary before first-trimester
abortion, current US guidelines are mixed regarding whether routine Rh testing and
Rho(D) immune globulin are required. We sought to assess knowledge of blood type,
interest in Rh testing, and Rho(D) immune globulin received if Rh-negative among patients
receiving direct-to-patient telehealth for medication abortion care and who would
not otherwise need to travel to a clinic for care.
Methods
We analyzed survey data from patients obtaining medication abortion through telehealth
in 21 states and Washington, DC as part of the California Home Abortion by Telehealth
Study between October 2020 and January 2021. The survey included questions about patients’
blood type, interest in receiving Rh testing, and whether Rh-negative patients have
received Rho(D) immune globulin. Clinics counseled patients about low risks of Rh
sensitization early in pregnancy.
Results
Among all 1,378 respondents who answered survey questions on Rh, 713 (51.7%) patients
knew their blood type and among these, 172 (24.1%) reported they were Rh-negative.
One clinic asked all patients with unknown blood types (n=202) about their interest
in Rh testing, among whom 201 (99.5%) were not interested in Rh testing. Among Rh-negative
patients, 2.91% did obtain Rho(D) immune globulin.
Conclusions
Most patients who choose telehealth services for medication abortion are not interested
in Rh testing or have not received Rho(D) immune globulin. Guidelines that continue
to mandate Rh testing and Rho(D) immune globulin for first-trimester abortions should
be reconsidered based on low patient interest and lack of demonstrated clinical necessity
in the existing literature.
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Copyright
© 2022 Published by Elsevier Inc.
